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Ethical Perspectives in Using Technology-Enabled Research for Key HIV Populations in Rights-Constrained Settings. 在权利受限的环境中使用技术支持研究关键艾滋病毒人群的伦理观点。
IF 4.6 2区 医学 Q1 Medicine Pub Date : 2023-06-01 DOI: 10.1007/s11904-023-00654-0
Lidia Flores, Sean D Young

Purpose of review: People who use illicit drug substances (e.g., heroin) and sex workers are vulnerable to acquiring HIV. Due to the criminalization of illicit drug substances and sex work in many countries, these populations often reside in rights-constrained settings where their well-being, freedom, and access to HIV prevention and care services may be compromised due to legal prosecutions and societal stigma.

Recent findings: This study conducted a literature review on papers that evaluated a combination of the following three components: ethics, technology-based research, and populations who use drug substances and/or sex workers. We explored research on these ethical perspectives from both key populations and researchers. Findings revealed potential risks in data security and possible harmful implications of compromised data within these rights-constrained settings. Best practices were explored within the literature to identify potential methods for addressing these ethical concerns and improving HIV prevention and care.

审查目的:使用非法药物(如海洛因)的人和性工作者容易感染艾滋病毒。由于许多国家将非法药物和性工作定为刑事犯罪,这些人群往往生活在权利受限的环境中,由于法律起诉和社会污名,他们的福祉、自由和获得艾滋病毒预防和护理服务的机会可能受到损害。最近的发现:本研究对评估以下三个组成部分的论文进行了文献综述:伦理、基于技术的研究、使用药物的人群和/或性工作者。我们从关键人群和研究人员的角度探讨了这些伦理观点的研究。调查结果揭示了数据安全方面的潜在风险,以及在这些权利受限的设置中受损数据可能产生的有害影响。在文献中探讨了最佳实践,以确定解决这些伦理问题和改善艾滋病毒预防和护理的潜在方法。
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引用次数: 0
The End Is in Sight: Current Strategies for the Elimination of HIV Vertical Transmission. 终点在望:消除艾滋病毒垂直传播的当前战略。
IF 4.6 2区 医学 Q1 Medicine Pub Date : 2023-06-01 DOI: 10.1007/s11904-023-00655-z
Lanbo Yang, Mary Catherine Cambou, Karin Nielsen-Saines

Purpose of review: The goal of this review is to highlight and interpret recent trends and developments in the diagnosis, treatment, and prevention of HIV vertical transmission from a clinical perspective.

Recent findings: Universal third-trimester retesting and partner testing may better identify incident HIV among pregnant patients and result in early initiation of antiretroviral therapy to prevent vertical transmission. The proven safety and efficacy of integrase inhibitors such as dolutegravir may be particularly useful in suppressing viremia in pregnant persons who present late for ART treatment. Pre-exposure prophylaxis (PrEP) during pregnancy may play a role in preventing HIV acquisition; however, its role in preventing vertical transmission is difficult to elucidate. Substantial progress has been made in recent years to eliminate HIV perinatal transmission. Future research hinges upon a multipronged approach to improving HIV detection, risk-stratified treatment strategies, and prevention of primary HIV infection among pregnant persons.

综述目的:本综述的目的是从临床角度强调和解释HIV垂直传播的诊断、治疗和预防的最新趋势和发展。最近的发现:普遍的妊娠晚期再检测和伴侣检测可以更好地识别怀孕患者中的HIV事件,并导致早期开始抗逆转录病毒治疗以防止垂直传播。整合酶抑制剂(如多替格拉韦)已被证实的安全性和有效性可能对抑制抗逆转录病毒治疗晚期孕妇的病毒血症特别有用。妊娠期暴露前预防(PrEP)可能在预防艾滋病毒感染方面发挥作用;然而,它在防止垂直传播方面的作用很难阐明。近年来,在消除艾滋病毒围产期传播方面取得了实质性进展。未来的研究取决于多管齐下的方法来改善艾滋病毒检测、风险分层治疗策略和预防孕妇中的原发性艾滋病毒感染。
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引用次数: 0
The human microbiome and gut-liver axis in people living with HIV. 艾滋病毒感染者的人体微生物组和肠道-肝脏轴。
IF 3.7 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2023-06-01 Epub Date: 2023-05-02 DOI: 10.1007/s11904-023-00657-x
Maria J Duarte, Phyllis C Tien, Ma Somsouk, Jennifer C Price

Purpose of review: Chronic liver disease is a major cause of morbidity and mortality amongst people living with HIV (PLWH). Emerging data suggests that gut microbial translocation may play a role in driving and modulating liver disease, a bi-directional relationship termed the gut-liver axis. While it is recognized that PLWH have a high degree of dysbiosis and gut microbial translocation, little is known about the gut-liver axis in PLWH.

Recent findings: Recent studies have shown that microbial translocation can directly lead to hepatic inflammation, and have linked gut microbial signatures, dysbiosis, and translocation to liver disease in PLWH. Additionally, multiple trials have explored interventions targeting the microbiome in PLWH. Emerging research supports the interaction between the gut microbiome and liver disease in PLWH. This offers new opportunities to expand our understanding of the pathophysiology of liver disease in this population, as well as to explore possible clinical interventions.

审查目的:慢性肝病是艾滋病病毒感染者(PLWH)发病和死亡的主要原因。新出现的数据表明,肠道微生物转位可能在驱动和调节肝脏疾病方面发挥作用,这种双向关系被称为肠道-肝脏轴。虽然人们认识到 PLWH 存在严重的菌群失调和肠道微生物转位,但对 PLWH 的肠道-肝脏轴却知之甚少:最近的研究表明,微生物易位可直接导致肝脏炎症,并将 PLWH 的肠道微生物特征、菌群失调和易位与肝脏疾病联系起来。此外,多项试验还探索了针对 PLWH 微生物群的干预措施。新近的研究证实,在 PLWH 患者中,肠道微生物组与肝病之间存在相互作用。这为我们进一步了解该人群肝病的病理生理学以及探索可能的临床干预措施提供了新的机遇。
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引用次数: 0
Implementing Geospatial Science and Technology to Get to Zero New HIV Infections. 利用地理空间科学技术实现艾滋病毒零新增感染。
IF 4.6 2区 医学 Q1 Medicine Pub Date : 2023-06-01 DOI: 10.1007/s11904-023-00658-w
Enbal Shacham, Stephen E Scroggins, Matthew Ellis

Purpose of review: Tremendous advancements have been made in HIV treatment and prevention during the last 40 years that zero new HIV cases has become an attainable goal declared by international agencies. However, new cases of HIV infection persist.

Recent findings: The emerging field of geospatial science is positioned to play key role in the reduction of continued HIV incidence through technology-driven interventions and innovative research that gives insights into at-risk populations. As these methods become more utilized, findings consistently show the important role of location and environment plays in HIV incidence and treatment adherence. This includes distance to HIV provider, locations of where HIV transmissions occurs compared to where people with HIV reside, and how geospatial technology has been leveraged to identify unique insights among varying groups of those at increased risk for HIV, among others. Given these insights, leveraging geospatial technology would play a prominent role in achieving zero new cases of HIV infections.

审查目的:在过去40年里,艾滋病毒治疗和预防取得了巨大进展,零新发艾滋病毒病例已成为国际机构宣布的可实现的目标。然而,新的艾滋病毒感染病例持续存在。最新发现:地理空间科学这一新兴领域将通过技术驱动的干预措施和深入了解高危人群的创新研究,在降低艾滋病毒持续发病率方面发挥关键作用。随着这些方法得到越来越多的应用,研究结果一致表明,地点和环境在艾滋病毒发病率和治疗依从性中起着重要作用。这包括与艾滋病毒提供者的距离,与艾滋病毒感染者居住的地方相比,艾滋病毒传播发生的地点,以及如何利用地理空间技术来确定艾滋病毒感染风险增加的不同群体的独特见解等。鉴于这些见解,利用地理空间技术将在实现零艾滋病毒感染新病例方面发挥重要作用。
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引用次数: 0
Reporting Individual-Level Research Results from Neurocognitive and Psychological Research in People Living with HIV: Lessons from Dementia Research. 报告艾滋病毒感染者神经认知和心理研究的个体水平研究结果:来自痴呆症研究的经验教训。
IF 4.6 2区 医学 Q1 Medicine Pub Date : 2023-06-01 DOI: 10.1007/s11904-023-00650-4
Holly L Peay, Stuart Rennie, Gail E Henderson

Purpose of review: There are growing expectations for the return of individual-level research results (RoR), which promotes autonomy and potential clinical and personal benefits. There are ethical and practical challenges, however, that may be exacerbated in research that assesses neurocognitive and psychological outcomes, including HIV-associated neurocognitive disorder (HAND). This paper reviews central concepts for RoR and recent empirical and conceptual articles from Alzheimer's disorder (AD) as a model for HIV.

Recent findings: Data from AD studies indicate high participant interest and low risk of harm from RoR, though additional research is needed. Investigators report a range of benefits, potential risks, and feasibility concerns. Standardized, evidence-based approaches are needed for RoR. For HIV research, we recommend a default position of offering RoR for cognitive and psychological outcomes. Investigators should justify decisions not to return results after assessing the potential value and feasibility of RoR. Longitudinal research is needed for feasible and evidence-based best practices.

综述目的:人们对个体水平研究结果(RoR)的回报期望越来越高,这促进了自主性和潜在的临床和个人利益。然而,在评估神经认知和心理结果的研究中,包括艾滋病毒相关的神经认知障碍(HAND),可能会加剧伦理和实践方面的挑战。本文回顾了RoR的核心概念以及最近阿尔茨海默病(AD)作为HIV模型的经验和概念性文章。最近的发现:来自AD研究的数据表明,参与者的兴趣高,RoR的危害风险低,尽管还需要进一步的研究。研究者报告了一系列的益处、潜在风险和可行性问题。RoR需要标准化的、基于证据的方法。对于艾滋病毒研究,我们建议默认为认知和心理结果提供RoR。在评估RoR的潜在价值和可行性后,研究者应该为不返回结果的决定辩护。需要进行纵向研究以确定可行的、以证据为基础的最佳做法。
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引用次数: 0
Mapping Community-Engaged Implementation Strategies with Transgender Scientists, Stakeholders, and Trans-Led Community Organizations. 与跨性别科学家、利益相关者和跨性别领导的社区组织一起制定社区参与实施战略。
IF 3.7 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2023-06-01 Epub Date: 2023-04-04 DOI: 10.1007/s11904-023-00656-y
Arjee Restar, Brian J Minalga, Ma Irene Quilantang, Tyler Adamson, Emerson Dusic, Leigh-Ann van der Merwe, Greg Millet, Danvic Rosadiño, Tanya Laguing, Elle Lett, Avery Everhart, Gregory Phillips, Rena Janamnuaysook, Pich Seekaew, Kellan Baker, Florence Ashley, Jeffrey Wickersham, Stephaun E Wallace, Don Operario, Kristi E Gamarel

Purpose of review: Pre-exposure prophylaxis (PrEP) represents one of the most effective methods of prevention for HIV, but remains inequitable, leaving many transgender and nonbinary (trans) individuals unable to benefit from this resource. Deploying community-engaged PrEP implementation strategies for trans populations will be crucial for ending the HIV epidemic.

Recent findings: While most PrEP studies have progressed in addressing pertinent research questions about gender-affirming care and PrEP at the biomedical and clinical levels, research on how to best implement gender-affirming PrEP systems at the social, community, and structural levels remains outstanding. The science of community-engaged implementation to build gender-affirming PrEP systems must be more fully developed. Most published PrEP studies with trans people report on outcomes rather than processes, leaving out important lessons learned about how to design, integrate, and implement PrEP in tandem with gender-affirming care. The expertise of trans scientists, stakeholders, and trans-led community organizations is essential to building gender-affirming PrEP systems.

综述目的:暴露前预防(PrEP)是预防艾滋病毒最有效的方法之一,但仍然不公平,使许多跨性别和非二元(跨性别)个体无法从这一资源中受益。针对跨性别人群部署社区参与的PrEP实施战略对于结束艾滋病毒流行至关重要。最近的发现:尽管大多数PrEP研究在生物医学和临床层面解决了有关性别确认护理和PrEP的相关研究问题,但关于如何在社会、社区和结构层面最好地实施性别确认PrEP系统的研究仍然悬而未决。必须更加充分地发展社区参与实施的科学,以建立确认性别的PrEP系统。大多数已发表的针对跨性别者的PrEP研究报告的是结果,而不是过程,忽略了关于如何设计、整合和实施PrEP以及性别确认护理的重要经验教训。跨性别科学家、利益相关者和跨性别领导的社区组织的专业知识对于建立性别确认的PrEP系统至关重要。
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引用次数: 0
Biological Aging in People Living with HIV on Successful Antiretroviral Therapy: Do They Age Faster? 成功接受抗逆转录病毒治疗的艾滋病毒感染者的生物衰老:他们衰老得更快吗?
IF 4.6 2区 医学 Q1 Medicine Pub Date : 2023-04-01 DOI: 10.1007/s11904-023-00646-0
Sara Svensson Akusjärvi, Ujjwal Neogi

Purpose of review: In the absence of a prophylactic/therapeutic vaccine or cure, the most amazing achievement in the battle against HIV was the discovery of effective, well-tolerated combination antiretroviral therapy (cART). The primary research question remains whether PLWH on prolonged successful therapy has accelerated, premature, or accentuated biological aging. In this review, we discuss the current understanding of the immunometabolic profile in PLWH, potentially associated with biological aging, and a better understanding of the mechanisms and temporal dynamics of biological aging in PLWH.

Recent findings: Biological aging, defined by the epigenetic alterations analyzed by the DNA methylation pattern, has been reported in PLWH with cART that points towards epigenetic age acceleration. The hastened development of specific clinical geriatric syndromes like cardiovascular diseases, metabolic syndrome, cancers, liver diseases, neurocognitive diseases, persistent low-grade inflammation, and a shift toward glutamate metabolism in PLWH may potentiate a metabolic profile at-risk for accelerated aging.

综述目的:在缺乏预防性/治疗性疫苗或治愈方法的情况下,抗击艾滋病毒的最惊人成就是发现了有效且耐受性良好的抗逆转录病毒联合疗法(cART)。主要的研究问题仍然是长期成功治疗的PLWH是否会加速、过早或加剧生物衰老。在这篇综述中,我们讨论了目前对PLWH中可能与生物衰老相关的免疫代谢谱的理解,并更好地了解PLWH中生物衰老的机制和时间动态。最近的发现:生物衰老,由DNA甲基化模式分析的表观遗传改变定义,已经在PLWH与cART中报道,指出表观遗传年龄加速。特定临床老年综合征的加速发展,如心血管疾病、代谢综合征、癌症、肝脏疾病、神经认知疾病、持续的低度炎症,以及PLWH向谷氨酸代谢的转变,可能会增加加速衰老的代谢风险。
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引用次数: 2
HIV Reservoir: How to Measure It? HIV病毒库:如何测量?
IF 4.6 2区 医学 Q1 Medicine Pub Date : 2023-04-01 DOI: 10.1007/s11904-023-00653-1
Xinyu Zhang, Jun Chen

Purposeof review: In the current quest for a complete cure for HIV/AIDS, the persistence of a long-lived reservoir of cells carrying replication-competent proviruses is the major challenge. Here, we describe the main elements and characteristics of several widely used assays of HIV latent reservoir detection.

Recent findings: To date, researchers have developed several different HIV latent reservoir detection assays. Among them, the in vitro quantitative viral outgrowth assay (QVOA) has been the gold standard for assessing latent HIV-1 viral load. The intact proviral DNA assay (IPDA) based on PCR also demonstrated the predominance of defective viruses. However, these assays all have some drawbacks and may still be inadequate in detecting the presence of ultralow levels of latent virus in many patients who were initially thought to have been cured, but eventually showed viral rebound. An accurate and precise measurement of the HIV reservoir is therefore needed to evaluate curative strategies, aimed to functional cure or sterilizing cure.

综述目的:在目前寻求完全治愈HIV/AIDS的过程中,携带具有复制能力的原病毒的长寿命细胞库的持久性是主要的挑战。在这里,我们描述了几种广泛使用的HIV潜伏库检测方法的主要成分和特点。最新发现:迄今为止,研究人员已经开发了几种不同的HIV潜伏库检测方法。其中,体外定量病毒生长测定(QVOA)已成为评估HIV-1潜伏病毒载量的金标准。基于PCR的完整原病毒DNA分析(IPDA)也显示缺陷病毒的优势。然而,这些检测方法都有一些缺点,并且可能仍然不足以检测许多最初被认为已经治愈但最终显示病毒反弹的患者中超低水平潜伏病毒的存在。因此,需要对艾滋病毒储存库进行准确和精确的测量,以评估治疗策略,旨在功能性治愈或灭菌治愈。
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引用次数: 1
Immunologic Interplay Between HIV/AIDS and COVID-19: Adding Fuel to the Flames? 艾滋病毒/艾滋病与新冠肺炎之间的免疫相互作用:火上浇油?
IF 3.7 2区 医学 Q2 INFECTIOUS DISEASES Pub Date : 2023-04-01 Epub Date: 2023-01-21 DOI: 10.1007/s11904-023-00647-z
Matteo Augello, Valeria Bono, Roberta Rovito, Camilla Tincati, Giulia Marchetti

Purpose of review: HIV/AIDS and COVID-19 have been the major pandemics overwhelming our times. Given the enduring immune disfunction featuring people living with HIV (PLWH) despite combination antiretroviral therapy (cART), concerns for higher incidence and severity of SARS-CoV-2 infection as well as for suboptimal responses to the newly developed vaccines in this population arose early during the pandemics. Herein, we discuss the complex interplay between HIV and SARS-CoV-2, with a special focus on the immune responses to SARS-CoV-2 natural infection and vaccination in PLWH.

Recent findings: Overall, current literature shows that COVID-19 severity and outcomes may be worse and immune responses to infection or vaccination lower in PLWH with poor CD4 + T-cell counts and/or uncontrolled HIV viremia. Data regarding the risk of post-acute sequelae of SARS-CoV-2 infection (PASC) among PLWH are extremely scarce, yet they seem to suggest a higher incidence of such condition. Scarce immunovirological control appears to be the major driver of weak immune responses to SARS-CoV-2 infection/vaccination and worse COVID-19 outcomes in PLWH. Therefore, such individuals should be prioritized for vaccination and should receive additional vaccine doses. Furthermore, given the potentially higher risk of developing long-term sequelae, PLWH who experienced COVID-19 should be ensured a more careful and prolonged follow-up.

审查目的:艾滋病毒/艾滋病和新冠肺炎是我们时代的主要流行病。考虑到尽管联合抗逆转录病毒疗法(cART)仍存在艾滋病毒感染者(PLWH)的持久免疫功能障碍,在大流行早期,人们就开始担心严重急性呼吸系统综合征冠状病毒2型感染的发病率和严重程度更高,以及对新开发疫苗的反应不理想。在此,我们讨论了HIV和SARS-CoV-2之间的复杂相互作用,特别关注PLWH对SARS-CoV-2自然感染和疫苗接种的免疫反应。最近的研究结果:总体而言,当前文献表明,在CD4较差的PLWH中,新冠肺炎的严重程度和结果可能更糟,对感染或疫苗接种的免疫力较低 + T细胞计数和/或未控制的HIV病毒血症。关于PLWH中严重急性呼吸系统综合征冠状病毒2型感染(PASC)急性后遗症风险的数据极为稀少,但它们似乎表明这种情况的发生率更高。缺乏免疫病毒学控制似乎是PLWH对SARS-CoV-2感染/疫苗接种的免疫反应较弱和新冠肺炎结果恶化的主要驱动因素。因此,这些人应优先接种疫苗,并应获得额外的疫苗剂量。此外,鉴于发生长期后遗症的潜在更高风险,应确保经历新冠肺炎的PLWH进行更仔细和更长时间的随访。
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引用次数: 0
Updates on HIV and Kidney Disease. 艾滋病毒和肾脏疾病的最新情况。
IF 4.6 2区 医学 Q1 Medicine Pub Date : 2023-04-01 DOI: 10.1007/s11904-023-00645-1
C Elena Cervantes, Mohamed G Atta

Purpose of review: With the advent of antiretroviral therapy, HIV infection has become a chronic disease in developed countries.

Recent findings: Non-HIV-driven risk factors for kidney disease, such as APOL1 risk variants and other genetic and environmental factors, have been discovered and are better described. Consequently, the field of HIV-associated kidney disease has evolved with greater attention given to traditional risk factors of CKD and antiretroviral treatment's nephrotoxicity. In this review, we explore risk factors of HIV-associated kidney disease, diagnostic tools, kidney pathology in HIV-positive individuals, and antiretroviral therapy-associated nephrotoxicity.

综述目的:随着抗逆转录病毒疗法的出现,艾滋病毒感染在发达国家已成为一种慢性病。最近的发现:肾脏疾病的非艾滋病毒驱动的危险因素,如APOL1风险变异和其他遗传和环境因素,已经被发现并得到了更好的描述。因此,随着对CKD的传统危险因素和抗逆转录病毒治疗的肾毒性的更多关注,hiv相关肾脏疾病领域已经发展。在这篇综述中,我们探讨了hiv相关肾脏疾病的危险因素、诊断工具、hiv阳性个体的肾脏病理以及抗逆转录病毒治疗相关的肾毒性。
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引用次数: 1
期刊
Current HIV/AIDS Reports
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